Plagiocephaly Intervention: Positioning and Remoulding

Treatment protocols for nonsynostotic deformational plagiocephaly

Plagiocephaly intervention must be considered with regard to several different factors. These include the infant’s age, the severity of the deformity and the presence or absence of related issues (facial deformity, torticollis, otitis media etc.). Close collaboration is required between the child’s parents, primary healthcare provider and any orthotic and craniofacial specialists involved.

Stage 1: Repositioning

This involves placing the infant in prone positioning during play, and minimising pressure on the back of the head when carrying, feeding, cuddling, dressing and bathing the baby.

Although the infant should always sleep supine, the position of the head may be subtly manipulated, for instance by turning the cot through 180 degrees once a week to encourage the baby to face in alternating directions.

A print-out guide to repositioning and tummy time can be found on the CHOA website. These techniques are only effective until infants are to roll over independently, at which point further measures may be required.

Stage 2: Referral

Torticollis can interfere with repositioning so if one is present, the baby should be treated with physical therapy.

If the deformity remains moderate or severe at around four or five months of age, the primary paediatrician or physical therapist may refer the baby to a craniofacial unit to rule out craniosynostosis.

At this stage, a CRO (cranial remoulding orthosis) is the only effective intervention for plagiocephaly.

Stage 3: Cranial remoulding

CROs are a plagiocephaly intervention consisting of a custom-made helmet or band, which is used to gradually ease the cranial bones into a more regular, symmetrical alignment.

First, the head is measured or scanned and the parents are provided with the data to inform their decision. If they choose to go ahead with treatment, a helmet is constructed to leave room for growth in flattened areas of the skull whilst applying passive pressure to the prominent areas.

The device is worn for 23 hours a day, usually over a period of 3 – 6 months, and adjusted at regular intervals to ensure optimal fit and correction. Success is dependent on severity, age at start of treatment and parental compliance.

CROs are available from private orthotic clinics and cost around £2000. The NHS rarely funds this treatment (why not?), but financial assistance can sometimes be provided by charities such as HeadStart4Babies and Tree of Hope.

Treatment must be started at between four and 14 months of age, and the earlier the better. At one year, the skull becomes less malleable, the cranial sutures close and the head shape becomes permanent.

Talking to parents

The below presentation provides a brief overview of the symptoms and signs of plagiocephaly, its causes, methods for prevention and options for intervention.